title: Palliative sedation at home in the Netherlands: a nationwide survey among nurses.
abstract: OBJECTIVE
  This paper is a report of a nationwide study conducted to assess experiences of nurses involved in palliative sedation at home after introduction of a physicians' guideline for palliative sedation.
  
  
  BACKGROUND
  Most studies investigating the practice of palliative sedation focus on physicians' practices and attitudes. However, little is known about experiences and attitudes of nurses.
  
  
  METHODS
  A web-based structured questionnaire was offered to 387 nurses providing medical technical care in 2007, assessing their experiences concerning decision-making, treatment policy and communication, focussing on the last patient receiving palliative sedation.
  
  
  RESULTS
  The questionnaire was filled out by 201 nurses (response rate 52%). The majority of respondents agreed with the indication for palliative sedation. However, 21% reported to have refused carrying out a palliative sedation in the preceding year. The general practitioner was not present at the start of palliative sedation in a third of the cases, but was available when needed. The sedation was considered insufficiently effective by 42% of the respondents. According to a third of the respondents, the level of sedation was not related to the required level of symptom relief nor were changes in dosage based on the severity of symptoms.
  
  
  CONCLUSIONS
  Although the guideline for palliative sedation appears to be followed adequately in the majority of cases with respect to indication for palliative sedation and reportage. The survey findings revealed shortcomings in medication policy, communication, medical control over the start and continued monitoring of palliative sedation.
authors.affiliation: Department of Anesthesiology, VU University Medical Center, Amsterdam, The Netherlands. t.brinkkemper@vumc.nl
authors.forename: Tijn
authors.initials: T
authors.lastname: Brinkkemper
authors.forename: Marianne
authors.initials: M
authors.lastname: Klinkenberg
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
authors.forename: Miriam
authors.initials: M
authors.lastname: Eliel
authors.forename: Judith A C
authors.initials: JA
authors.lastname: Rietjens
authors.forename: Wouter W A
authors.initials: WW
authors.lastname: Zuurmond
authors.forename: Roberto S G M
authors.initials: RS
authors.lastname: Perez
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D003657:Decision Making; D054810:Deep Sedation / Q000379:methods / Q000451:nursing*; D005194:Family Practice; D005260:Female; D005440:Fluid Therapy / Q000451:nursing; D019983:Guideline Adherence / Q000592:standards; D007722:Health Knowledge, Attitudes, Practice; D006699:Home Care Services; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D009020:Morphine / Q000008:administration & dosage; D009426:Netherlands; D024802:Nurse's Role; D010166:Palliative Care / Q000379:methods*; D019555:Physician-Nurse Relations; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D009020:Morphine